Healthcare Provider Details

I. General information

NPI: 1063651669
Provider Name (Legal Business Name): UINTAH BASIN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EAST 200 SOUTH
DUCHESNE UT
84021
US

IV. Provider business mailing address

PO BOX 905 50 EAST 200 SOUTH
DUCHESNE UT
84021-0905
US

V. Phone/Fax

Practice location:
  • Phone: 435-738-5403
  • Fax: 435-738-5405
Mailing address:
  • Phone: 435-738-5403
  • Fax: 435-738-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7263753-1703
License Number StateUT

VIII. Authorized Official

Name: BRENT HALES
Title or Position: CFO
Credential:
Phone: 435-722-6164